ICU Clinical pharmacy practice

22/10/2022

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Honesty , concern, passion, excellence, and teamwork. We have developed five principles for managing our work and achieving excellence in healthcare practice.

In our Online ICU Practice Course we provide you with a real ICU experience through blending therapeutic knowledge, experience, and judgment to ensure optimal patient outcomes.
With all our passion we will help you develop clinical pharmacy skills including case analysis, confident discussion and intervention.
Our first virtual round will start by the 1st of December.
For more information or reservation please contact us.
Mob: 01141086797
Email: alaahamid134@gmail.com

08/01/2022

Paxlovid
1st FDA approved antiviral against covid 19 :

📍What is the indication ?
COVID-19, treatment, mild to moderate (outpatients with high risk of progression to severe illness) after covid19 diagnosis , NOT USED FOR PROPHYLAXIS.
Not for severe symptoms .

📍Dosing in adult :
Nirmatrelvir 300 mg with ritonavir 100 mg, administered together, twice daily for 5 days

📍Renal modification :
Not recommended if crcl < 30 ml /min
eGFR ≥30 to

03/01/2022

📝Did you know that:

Noradrenaline ampoule (8mg/4ml) is NOT double levopherine ampoule (4mg/4ml)

1ml (2mg) of noradrenaline tartate (salt) is equivalent to 1ml (1mg) of noradrenaline (base)

15/04/2021

Part 2 >>
Triazole antifungals :
📌Fluconazole :
▪️spectrum :
Against ✅candidal infection ( except candida Krusei and GLabrata)

▪️Formulation: IV and oral
IV=Oral ( excellent bioavailability)

▪️Dosing :
Has Renal adjustment .
No hepatic adjustment .

▪️ monitoring parameters:
Periodic liver function tests (AST, ALT, alkaline phosphatase) and renal function tests, potassium

- 📌Voriconazole (Vfend) :
▪️spectrum :
Against ✅ Aspergillus sp.
✅ Candidal sp. ( Include candida Krausi)
✅fusarium sp.
✅ various molds

▪️ formations: IV and Oral route .

▪️Dosing:
Has Renal adjustment :
If crcl 28 days; phototoxic reactions (especially in pediatric patients); pancreatic function (in patients at risk for acute pancreatitis); total body skin examination yearly (more frequently if lesions noted).

05/03/2021

Part 1>>
Echinocandins Antifungals:
are a class of antifungal drugs that inhibit the synthesis of β-glucan in the fungal cell wall.

Echinocandins includes:
✔Caspofungin ( Cancidas 50mg, 70 mg IV)
✔ Micafungin (Mycamine 50 mg IV)
✔Anidulafungin ( Ecalta 100 mg IV)

▪️Spectrum:
Aspergillus +/-
Candida ++

▪️Formulation: all of them IV only

▪️Dosing

1. Caspofungin: 70 mg on day 1; then 50 mg once daily
▪︎hepatic dose adjustment is recommended in adults with moderate impairment (Child-Pugh class 😎 , BUT NO renal dosage adjustment inecessary.

🚫 Increased transaminas have been reported, monitor LFTs during therapy; consider discontinuation if tests increased and use with caution in patients with hepatic impairment.

2. Micafungin: 100 to 150 mg once daily.
▪︎NO hepatic or renal adjustment necessary

🚫 New-onset or worsening hepatic impairment has been reported. Monitor LFTs closely.

🚫 It may increase the risk of AKI so use with caution in patients that develop worsening renal function during treatment; monitor closely.

3. Anidulafungin: Initial dose 200 mg on day 1; then 100 mg once daily.
▪︎NO hepatic or renal adjustment necessary, including dialysis patients.

🚫 Elevated LFTs, hepatitis, and hepatic failure have been reported; monitor LFTs.

26/01/2021

Heparin-induced thrombocytopenia (HIT) :
It is a life-threatening complication of exposure to heparin (ie, unfractionated heparin, low molecular weight [LMW] heparin) that occurs in up to 5 percent of patients exposed, regardless of the dose, schedule, or route of administration.

▪️Timing: the typical onset of thrombocytopenia occurs 5 to 10 days after the initiation of heparin therapy.

▪️Manifestation: Thrombocytopenia — (platelet count 50 percent of baseline is typical;) is the most common manifestation of HIT

▪️Management:
✔Immediate discontinuation of all heparin exposure ( including unfractionated heparin & LMW heparin)
✔Start full-dose therapeutic anticoagulation with a non-heparin anticoagulant. This include:
1.parenteral direct thrombin inhibitors (eg, argatroban, bivalirudin), Fondaparinux
2. OR direct oral anticoagulants (DOACs) such as apixaban, edoxaban, rivaroxaban, or dabigatran

06/01/2021

▪️Drug informatiom: Midazolam in ICU sedation (Review the last 2 posts )
▪️Midazolam (dormicum or Midathetic):
✔ benzodiazepines have amnestic properties ( loss of memory for some events).
✔[US Boxed Warning]: it has been associated with respiratory depression most often when used concomitantly with other CNS depressants (eg, opioids).
✔Also may cause hypotension particularly in pediatrics and those receiving opioids.
Therefore continuous monitoring of respiratory (ie, pulse oximetry to monitor oxygen saturation) and cardic function (heart rate and blood pressure ) is required.

05/01/2021

▪️Drug information: precedex in icu sedation
( Review our last post)
▪️Dexmedetomidine (Precedex):
✔ It can be more suitable for patients who are NOT intubated ; however it require respiratory monitoring as it may causes minimal respiratory depression.
✔Unlike benzodiazepines, dexmedetomidine does not provide adequate and reliable amnesia (when necessary).
✔When used for ICU sedation, use of a loading dose is optional as episodes of bradycardia, hypotension, and sinus arrest have been associated with rapid IV administration (eg, bolus administration) or when given to patients with high vagal tone.
✔Use with caution in patients with heart block, bradycardia, severe ventricular dysfunction, and hypovolemia.
To be continued .....

02/01/2021

Drug informaton: propfol in ICU sedation
▪️Sedation in ICU:
Sedation is typically used to treat agitation and anxiety in critically ill patients that untreated may induce self-harm (extubation, displacement of IV line, etc)
When choosing sedative consider nonbenzodiazepines ( propofol, dexmedetomidine) over benzodiazepines (midazolam, lorazepam) to improve the clinical outcome.

▪️Propofol (diprivan):
✔If propofol is used contiouslly >48 hours, monitor for increasing Triglyceride and creatin kinase levels to avoid pancreatitis
✔Patient should be mechanically ventilated ( as propofol may cause apnea)
✔Hypotension is the major cardiovascular effect of propofol especially if patient is hypovolemic or if bolus dosing is used.
✔Avoid rapid bolus injection
To be continued ........

23/12/2020

Drug information:
▪️Vancomycin oral administeration.
Vancomycin has poor oral bioavaliability therefore oral route is ineffective for treating systemic infections. Oral route is effective only in treating C.difficile infections.
▪️Dose:
Initial episode: 125 mg 4 times daily for 10 days

16/12/2020

Drug information : Inhaled antibiotics
▪️inhaled antibiotics have lower systemic side effects than IV antibiotics

▪️For patients with VAP due to gram negative bacilli ( GNB) that are susceptible only to amino glycosides or polymixins ( colistin or polymixin B), we suggest both systemic and inhaled antibiotics rather than systemic alone ( weak recommendation, very low quality evidence)
▪️suggested doses :
◽️ colistin :
✔️Sanford guide —>50-75 mg CBA in 3-4 mL saline via nebulizer 2-3 times/day
✔️Lexicomp—>30 to 150 mg CBA via nebulizer 1 to 2 times daily (maximum dose: 150 mg CBA 2 times daily)
( to convert CBA to millions multiple by 30,000)

▫️Amikacin : 15-30 mg/kg administered in 1- 2 doses

07/12/2020

Drug information:
▪️High intensity statins examples:
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg

▪️indications:
1. LDL-C ≥190 mg/dL and age 20 to 75 years.
2.Secondary prevention in patients with established atherosclerotic cardiovascular disease.
3.Patients with diabetes and ASCVD risk >20% .